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PMID-02 Researcher Form

FPA application form for accredited fertilizer and pesticide researcher

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Control No. ___________________

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APPLICATION FOR ACCREDITATION
APPLICATION
ACCREDITATION
Accredited Fertilizer and Pesticide Researcher
Accredited Fertilizer and Pesticide Researcher
New
Date of training/last symposium attended: _______________

Renewal
Venue : _________________________________

FIELD OF DISCIPLINE:
Plant Nutrition/Fertilizer

Entomology

Plant Pathology

Supervised Pesticide Residue Trial (SPRT)

Weed Science

Others (Pls. specify)________________________

NAME
EMAIL ADDRESS
CONTACT NUMBER
COMPANY NAME/
UNIVERSITY
AFFILIATION
ADDRESS
I hereby certify that the above information is correct to the best of my knowledge.

Signature
Requirements to be
attached to this
application

1. Certificate of attendance to training/symposium
2. Latest Resume which includes academic specialization, training, published research
or current research undertakings, and years of research experience
for the discipline being applied for (Greenbook, Chapter 4.5.5.B)
3. Authorship of one (1) publication in a refereed journal or two(2) publications in
non-refereed journals along the discipline being applied for in case of
expansion of accreditation for additional research discipline
(Greenbook, Chapter 4.5.5.B)

PRIVACY NOTICE AND CONSENT TO USE DATA
We respect your privacy and keep your personal information confidential unless we are lawfully required or
allowed to disclose it or that you give your written consent to such disclosure.
CONSENT TO PROCESS AND SHARE DATA
In compliance with the Data Privacy Act, I hereby give my consent to the Fertilizer and Pesticide Authority to
share my contact details to its registered clients who need researchers with my field of discipline to conduct
field experiment to support fertilizer or pesticide product registration.
Signature of Researcher
FOR FPA USE ONLY:
Received by/Date:

:_________________

Official Receipt No.
____________________

Amount Paid

:_________________

Place

:_________________
 
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